6/27/2011 1:16 PM ET|
7 costly health insurance mistakes
Before you pick a policy, carefully evaluate what you need as well as how much risk you can afford to take. Also, keep your eyes open for potentially nasty surprises.
Poring over the fine print of health insurance plans to choose a policy is nobody's idea of fun, but you're better off spending some painstaking time researching before you buy than nursing a nasty financial headache later.
The "quality" of a health plan often depends on your needs and how much financial risk you can bear.
"One size doesn't fit all," says Martin Rosen, co-founder and executive vice president of Health Advocate, which helps employers and individual clients navigate the health care system. "You really need to assess what you need."
Whether you're choosing among group health plans offered by your employer or shopping for individual health insurance coverage, there are seven scenarios to avoid.
1. Your doctor isn't in the network
You'll pay more to use health care providers who aren't in your health plan's network, so check to see if the doctors and other professionals you want are included.
A plan that tightly restricts you to a local network might be sufficient if you need care only in your area, but it won't benefit a kid away at college or meet all your needs if you spend a lot of time on the road, says Pete Villemain, the president of Employee Benefit Services, which manages employer benefits plans.
Make sure any specialists you need are also covered by the plan, Rosen says. Don't assume a specialist is in the network just because your primary care doctor gave you the name.
2. You pay huge insurance premiums to save a few bucks on the co-pay
"The mistake I see individuals make so many times is they focus so much on getting a low co-pay and they fail to look at how much extra premium they pay for it," says Villemain.
He suggests evaluating how you'll use your plan and comparing the costs accordingly. If you go to the doctor only a couple of times a year, is it worth hundreds of dollars extra on the premium just to get a lower co-pay?
3. The drugs you take aren't covered
Some states require individual plans to offer prescription drug coverage, but in other states, many individual health insurance plans don't cover drugs, says benefits consultant Michael Goodheim of Farsighted Strategies in Seattle.
If the plan provides prescription-drug coverage, check to see if your medications are included on its formulary, which lists the preferred drugs for coverage, Goodheim says. Expect to pay more if you take a drug that is not listed.
Rosen suggests checking whether the plan provides discounts if you mail-order prescription drugs in bulk. For instance, you might be able to pay less per month for a 90-day supply through mail order than for three 30-day supplies at the pharmacy counter.
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Hot news flash! If you're priviledged enough to be able to choose a policy (rather than being grateful that your employer has anything), that means you're more than wealthy enough to pay for your drugs. Last time I checked, in order to afford a private insurance plan you had to have plenty of cash; that's why people stick with the horrific HMOs that refuse preventative care or reasonable treatment.
Until and unless universal health care passes in full, the non-wealthy are just plain ****ed. Welcome to the third world, America.
Oh but wait, if you were the third world, you'd have other nations providing health care for your poor. Like, say, the US (which sends health care abroad, but won't care for it's own because neocons won't dream of helping those not like them.
moorsb, If you don't think you have enough info then don't send the application in. That's like signing a contract that has a bunch of blank spaces. Insist on getting the info so you can make an informed decision before your sign or send any money in for anything. If that doesn't work, go somewhere else.
There are enough carriers that will send an agent to visit you at home so you can eyeball exactly what your coverage would be and what your exclusions would be BEFORE you sign anything.
move to canda or any other western industrialsed nation where basic health care is
taken for granted. why is the usa so behind?
Getting a real quote online is very costly. They quote you a low number at the beginning, but it is not until your application is processed that you get a real quote on the cost. They want you to pay the first month premium to get a real quote. At 300 - 500 per quote and a 30 day processing time how can you really get a real quote and know what you are going to wind up paying. Then they issue a policy that excludes every condition that you told them that you had in the past 5 years.
They should only be allowed to give you a quote based on the average of what they currently charge their exisiting policy holders in your age group.
ewent, I was addressing only the lower level of patient's dealing with insurance companies, not the high finance end.
I agree with what you have said and from the beginning have disliked the HMO concept for the reason you mention and the way they have treated and restricted the partner providers from practicing, did you know that there used to be gag rules put in to place by HMOs that restricted the member providers from talking bad about the HMOs, by contract? And Healthsouth, I used to work for them, they are NOT an insurance company but are providers of Physical Therapy and Hospitals, but yes the CEO, Richard Scrushey, put the screws to a lot of us and the system.
What you say is true on many levels, there needs to be a restructering of the system, there are to many BIG insurance companies, Cigna, Aetna, United HealthCare, etc, these are buying up the smaller companies. Perhaps there needs to be just a few companies, 2-3, still competative, but easier to handle.
Again what you are saying is a problem, what is the solutiion?
But I still say that patient education, at that level, is important.
hi nicholas- i don't think she'd make that much in canada- the government would cover her and her kid's medical bills but not give her a cushy income. maybe some retraining? but really in your country or mine there's always going to be people who try beat the system, but i think it would be really hard to live on welfare here. i think the idea is to get you over the hump so you're not on the street until you're working again. pumping out babies just doesn't pay. i just wish you could worry about your education and not medical costs. people should be able to work low paying jobs if that's all they can get and still have basic medical care. the insurance companies just aren't allowed to stick it to you here and they still seem to make lots of money.
on a reality scale our dollar is on par with yours and even with $60.000 that mother would be bringing her 5 kids up in a life of poverty and of course- no health care.. at least every child has the right to decent health care. all the best, nicholas, glen
With respect to your comments about Obamacare, I am noting this. Starting in 2014, in theory, insurance rates should go down instead of up. This should be due to the reason that there will be (again in theory) virtually universal insurance coverage, increasing the numbers of insured to pay into health insurance. Prior to that, uninsured would go to emergency rooms for care, which the hospitals (by law) were required to take in, but a per ermergency room visit is far costlier than a regular doctor's visit, and since uninsured did not pay for these emergency room visits the remaining people who had health insurance saw their premiums jacked up to cover uninsured health care costs in these emergency rooms. The principle in having universal health insurance is a sound one, as again, if the formerly uninsured (who must have health insurance in 2014) had access to a regular doctor instead of an emergency room, costs to insurers overall would drastically drop.
But on the other side of the coin, starting in 2014, health insurers are required to take in high risk preexisting cases such as people who have kidney failure, etc. The costs to the health insurers for these high risk cases will be horrendous, and by law, the insurers must spread the cost of these high risk cases throughout their subscriber base. I personally have Diabetes (no fault of my own, I got it throught Agent Orange exposure when I was in the Military in Vietnam which is by the way covered by the VA) and are considered high risk for private health insurance purposes. Currently, if I wanted to get any high risk private health insurance coverage, I would have to be unisured for six months and then enroll in a high risk health insurance pool where I would get subsidized premiums. After 2014 that will not be the case, for the high risk pool program will disappear, and I can then apply to any private insurance company to get coverage under Obamacare. Unfortunately, people like me will drive up the costs of private health insurance, but with the looming cuts on the horizon at the VA, I may have no chioce but to enroll in a private plan.
My personal opinion about the health insurance and health care system in the USA, is that it has been operated at a for profit greed based system for a number of years now. The health insurance company CEO's get their massive pay packages to deny needed care for their subscribers, in order to maximize their profits, the malpractice lawyers get their 40 percent cut on multimillion dollar malpractice awards, and the hospital chain administrators get their 7 figure salaries managing the whole system while doctors (residents) put in 30 hour days making 50 k a year, and nurses even being paid less. Nowhere else where you will find this but the good old USA, which due to this has a general quality of care equalling it to a country like Turkey.
In my work as an engineer, I have travelled the world, and have seen other healthcare scenarios providing more bang for the buck, as compared to the USA. For example, Japan whose people have an average life expectancy of 83 years with a per capita healfh care cost of about $ 3000.00 a year, versus the United States where the average life expectancy being 78 with about an $ 8000.00 per capita per year health care cost. Even our neighbor to the north, Canada has a life expectancy of about 80 with about a $ 5000.00 per capita per year cost. And Canada has socialized mediciine, where, except in Medicare, the USA does not.
Unfortunately dealing with health insurance primarily comes down to patient education. By this I mean the patient needs to know what their benefits are. I deal with insurance companies all day/every day as a patient accounts rep in a provider's office. If you call a carrier their job is to give you the least amount of information that's going to get you off the phone. If you haven't received an explanation of benefits (EOB) that explains how the claim was processed, demand one. Most patient's I talk to do not know what their deductible is or if they have a copay or coinsurance or even what they are.
The guy who complained the UHC wouldn't pay after his wife's car accident, UHC is medical insurance, not car insurance. They will not pay, he said that his car insurance and the other car insurance paid more than UHC did......that's what they are supposed to do!!!!!.
Unless you, the patient or subscriber, are willing to educate yourselves and find out what your benefits are then don't complain. It's like any contract, how many really read the insurance contract and ask questions before signing it, or just complain later and wonder why they are getting screwed by the insurance company. I really get tired of trying to help (educate) these people after the fact.
Group insurance coverage is determined by the company buying the coverage for the group, if there is a problem go to your human resources and complain. If you have individual coverage problems, find the agent who sold you the coverage. Granted, there is a very serious need for health reforms, but let's start with educating ourselves and trying some self help.
Nicholas, honestly you are about as ignorant as they come. 3/4 of the federal budget is spent on welfare programs??? Please educate yourself so you dont' make such a fool of yourself. It's very easy to find out where the majority of the federal budget goes. Programs for low income people are a very tiny, tiny portion of the budget. Your other statement about privatizing the health care industry, umm let me let you in on a big secret..... it already is. Private hospitals, private insurance companies all making billions in profits because guess what people have to have health coverage, it's not a want its a need so they can charge whatever and deny whomever they choose. Why do you think we in the US pay the most per person for health care that is getting worse and worse. You cannot have for profit health care, it is as simple as that.
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